Premature Infant Outcomes Linda Wallen, MD. Prevalence of Cerebral Palsy VLBW Infants - 1982-1994 MortalityCerebral Palsy (% live births)(% survivors)

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Presentation transcript:

Premature Infant Outcomes Linda Wallen, MD

Prevalence of Cerebral Palsy VLBW Infants MortalityCerebral Palsy (% live births)(% survivors) (O’Shea et al., 1998)

Survival & Outcome of Infants Weighing <800 g 1979 to 1994 (O’Shea et al., Pediatrics 100: , 1997)

Survival & Outcome of Infants, g 1994 to 1996 (Finer et al., Pediatrics 104: , 1999)

Survival & Outcome of Infants, < 1250 g Doernbecher NCC, 1995 to 1998

Bayley Scales at 30 Months for Infants Born at < 26 Weeks Gestation (EPIcure Group (UK) follow up Mar-Dec New England J Med 343:381, 2000) Individual Scores on Bayley Scales at 30 months by Gestational Age

From NICHD Network Follow-Up. Pediatrics. 105: , Adj. Risk for No Independent WalkingAdj. Risk for No Independent Feeding Risk Factors for Cerebral Palsy in Infants < 1000 g at Months Risk Factors for Cerebral Palsy in Infants < 1000 g at Months

From NICHD Network Follow-Up. Pediatrics. 105: , Adjusted Risk Factors for MDI < 70Adjusted Risk Factors for PDI < 70 Risk Factors for Severe Developmental Delay in Infants <1000 g at Months

Died (2%) No disability (49%) No data (1%) Other disability (25%) Severe disability (25%) (EPIcure Group (UK) follow up Mar-Dec New England J Med 343:381, 2000) 30 Month Outcome for Infants Born at < 26 Weeks

From NICHD Network Follow-Up. Pediatrics. 105: , NICHD Outcome of Infants g at Discharge

NICHD Outcome of Infants g at 18 Months From NICHD Network Follow-Up. Pediatrics. 105: , 2000.

NICHD Outcome of Infants g at18 Months From NICHD Network Follow-Up. Pediatrics. 105: , 2000.

Growth Failure in the ELBW Infant n Growth at 1 yr of infants g born –Head circumference < 10% = 35% (45/219) –Weight < 10% = 58% (75/219) –Length < 10% = 33% (42/219) n Growth at 6-7 yr of infants < 750 g born –Head circumference < 3% = 35% (24/68) –Weight < 3% = 22% (15/68) –Height < 3% = 25% (17/68) n Growth at 6-7 yr of infants g born –Head circumference < 3% = 14% (9/65) –Weight < 3% = 11% (7/65) –Height < 3% = 5% (3/65)

Outcomes of ELBW infants n Historical reasons for reliance on neurologic morbidities –Public misperception of prevalence of severe disability –Limitation of range of outcomes studied n Other health outcomes that are affected –Increased incidence of asthma –Increased visual perceptual & expressive language disabilities –Increased behavioral problems –Growth failure –Family and child perception of health and outcome –Psychological outcomes n Other factors which influence outcome = risk factors and post discharge environment, heavily influenced by maternal education, income level, smoking, poor maternal health (physical or mental)